101106453 - Permit - Laserfiche WebLink

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INSPECTOR RECORD SITE.WORK DATE ID/SIG COMMENTS OWNER BTIILDTR DEI CARATION I hereby affirm under penalry of perjury that I am exempt form the Contractors' License Law for the following reason (Soc.7031.5 Business and Profession Code): Any City or County which requires a pcrmit to construct. alter. improve. demolish or repair any structure, prior to its issuance. also rcquires the applicant for such permit to file a signed statement that he or shc is licensed pursuant to the provisions of the Contractor's Licensed Law (Chapter 9. Comrnencing with Section 7000 of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031 .5 by any applicant for a permit subjecs the applicant to a civil penalty of not more than five hundred dollars ($500). 9f . .r owner of the property. or my employees with wages as their sole compensation. will do the wort and the structune is nor intendod or offered for sale (Sec.7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of the property who builds or improves thereon. and who does such wort himself or herself or through his or her own anployees. provided that such improvonents arc not intended or offered for sale. tf. howwcr, the building or improvement is sold within one year of conrplcion. the Owner Builder will have the burden of proving that he or she did not build or improve dre properW ftr thâ‚¬ purpce of sale). IEt. .r owner of the propcrty. am exclusively contracting with licensed contractors to constnrct the project (Sec. 7044. Business and Profession Code: The Contractor's License l-aw does not apply to an owner of property who builds or improves thereon. and who contracts for such projects with a Contracto(s) licensed pursuant to the Contractor's License Law). No I "rn exempt under Section _. 8. & P.C. for this reason. WORKF.RS' COMPFNSATTON DFC| { RJATTON I hereby afTirm under penalty of perjury one of the following declarations: !t n"r. and will maintain a Certificare of Consent to Self-lnsure for workers' compâ‚¬nsation, as provided for by Section 3700 of the Labor Code. for the performance of the work for which the permit is issued. YES _l have and will maintain workers' compensation insurance. as required by Section 3700 of the kbor Code, for the pcrformance of the work for which this permit is issued. My workers' compensation insurance carier and policy number are: . ZudctrArnerlcanlnruranceCornpany Carrier: wc 0t.t$731-oa Policy Number: 1213112021 Expires: NO _l certifu that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California. and agrce that if I should become subject to the workcts' compensation provisions of Section 3700 of the Labor Code. I shall. forthwilh comply with those provisions.. WARNING: Failure to secure workers' compensation coverage is unlawful. and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation, damages as provided for the Section -i076 of the Labor Code. interest and attomey's fecs. Llcl'NSFn CONTR ACTOR nFCl ^ RJATION I hereby affrrm under penalty of perjury that I am licensed under provision of Chapter 9 (commencing with Section 7000) of Division -1 of the Business and Professions Code. and my license is in full force and effect. c-39 License Class:_ CONSTRUCTION I FNTUNG AGFNCY I hereby affirm under penalty of perjury that there is a construction lending agency for the pcrfornunce of the work for which this permit is issued (Sec. -i097. Civ. C.), Lender's Name: Lender's Address: APPI ICANT NFCI {RATION I herebv atlimr under penalty of perjury one of the followrng declarations: Denrol rtron Pernrr ls-Asbestos Not r l-r cation Federal Regul atrons (Trtle 40, Part6 ) !a Required Letterof Notification YEs f ccfliry that the federal regulations regarding asbestos removal are not applicable to this project. ttt I certiS, that t have read this application and state that the above information is correct. I agree to comply with atl City and Coturry ordinances and State Laws relating to building construction, and hereby authorizc representatives of this City and County to enter upon the above mentioned property for inspection purposes. Reroof Roof (Diaphragm Sheathing/Frame) Structural Final 5/tl[t t n>u(a ) Plumbing tl Under FIoor I Under Slab Rough Shower Pan / Tub Test Water Service Sewer / Sewer Cap Gas Air Pressure Test Plumbing Final Electrical Service (Meter I Panel) Grounding / Bonding Rough Electrical Final Mechanical Gas Air Pressure Test Rough Piping (HW, CW, etc.) Exhaust Ducts Mechanical Final Notes, Remarks, Etc.ecmot License Number